About Implementation Science

Implementation science is used in public health to help move from evidence to action. It explores how to take proven health ideas and make them work in everyday life. Instead of stopping at “what works,” implementation science focuses on “how to make it happen,” so that communities can benefit from programs and policies that improve health.  

In addition to identifying what works, implementation science principles can also be used to improve how public health practitioners approach the technical and adaptive aspects of implementing innovations.  

Implementing System-level Change For CYSHCN  

While Title V CYSHCN programs have long implemented direct services and individual initiatives, they are increasingly shifting toward system-level change—improving how entire service systems function to better meet the needs of Children and Youth with Special Health Care Needs (CYSHCN). 

System-level change is important for CYSHCN youth because their care often involves many parts working together, such as health care, schools, social services, and families. If these systems do not coordinate well, families face gaps in care, delays, or extra stress. System-level change means improving how these parts connect and work, so that care is easier to access, more consistent, and better-equipped to meet children’s needs. Change at this level also helps create policies and structures that support long-term health, not just short-term fixes. 

System-level interventions often involve implementing changes at multiple levels of a system simultaneously, in order to reform or improve an existing system of care. System-level interventions may lack a single “solution” or endpoint. This type of work requires sustained collaboration, adaptability, and a willingness to embrace both intended and unintended outcomes. A system-level approach can be transformative for CYSHCN populations, but may take longer and be more complex than individual evidence-based interventions aimed at addressing a particular health outcome.  

Title V CYSHCN programs are increasingly focused on system-level change; however, we recognize that this work looks different based on a variety of factors, including program capacity and the changing health care landscape. This guide is meant to support that dynamic process and help teams stay focused on the long-term impact of system-level change. 

Active Implementation Phases of System-level Change 

Improving the system of services for CYSHCN is a complex undertaking, and traditional frameworks designed for individual evidence-based interventions may not perfectly align with system change. The Active Implementation Stages Framework provides an overview of the nonlinear process of identifying effective interventions and rolling out the selected interventions to achieve the desired improved health outcomes. This framework has been used to support agencies as they navigate the implementation of well-defined, single interventions in a specific setting. Moving through all the implementation phases generally takes 3 to 5 years.  

Because system-level transformation involves more layers of complexity than implementing single interventions, we have modified the stages to better reflect the phases of system-level interventions. The phases outlined in this guide accommodate the type of system-level work undertaken by Title V CYSHCN programs, recognizing that system change is not linear, and the evidence is always emerging and evolving. 

The Four Active Implementation Phases 

Moving through the phases of a system change may take longer than expected. Often, one phase does not clearly end as another begins. There may be overlaps between the phases, and it may be necessary to revisit previous phases if circumstances (eg, partners, funding, organizational or environmental needs) change. For example, an organization can be in the full implementation phase with one part of a system-change initiative, while being in the exploration phase with another. 

Because system-level changes take time, it is important to identify both long-term outcomes of the system-level initiative and smaller, measurable, short-term outcomes to ensure you are on track to meet that long-term goal.  

The teams responsible for implementing a system-change initiative and moving through the phases will vary depending on the state/jurisdiction and structure of CYSHCN systems in those places. Generally, there are key people that should be considered as part of the team, including Title V leadership, team members with data and evaluation expertise, family leaders, youth or young adults, clinical or health care professionals, community or partner organization liaisons, and policy or system-level staff. Regardless of who is on the team, it is important that specific people are assigned to key tasks and decisions. A strong team makes sure everyone knows their role, has clear contacts, and follows a process to handle questions, challenges, and next steps. 

The phases of implementation detailed in this guide are meant to be descriptive, rather than prescriptive. By describing the evolution of a systems intervention, a team can adjust and ensure they are achieving fully effective and sustained changes.